Infra-low frequency neurofeedback training in Dravet syndrome: A case study

This case study examines how an intervention of infra-low frequency neurofeedback training (ILF-NFT) affects the symptomatology of an eight-year-old patient with Dravet syndrome (DS), a rare and highly disabling form of epilepsy. Our results demonstrate that ILF-NFT has improved the patient's sleep disturbance, has significantly reduced seizure frequency and severity, and has reversed neurodevelopmental decline, with positive development in intellectual and motor skills. No significant changes have been made to the patient's medication in the observed period of 2.5 years. Thus, we draw attention to ILF-NFT as a promising intervention in addressing DS symptomatology. Finally, we discuss the study's methodological limitations and warrant future studies to assess the effect of ILF-NFT in DS in more elaborate research designs.

Evaluating the efficacy of non-invasive brain stimulation techniques in managing pediatric epilepsy

BACKGROUND

Pediatric epilepsy significantly affects cognitive and developmental outcomes, with drug-resistant epilepsy (DRE) posing a major challenge. While pharmacological and surgical interventions remain standard treatments, they often fail in refractory cases. Non-Invasive Brain Stimulation (NIBS), including Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS), has emerged as a promising therapeutic alternative.

NEW METHOD

This study systematically reviews and compares the efficacy, safety, and feasibility of TMS and tDCS in pediatric epilepsy. The analysis evaluates seizure reduction, cognitive improvements, and treatment tolerability. A comparative assessment considers mechanisms of action, precision, accessibility, and clinical applications.

RESULTS

TMS and tDCS treatments produce a 30-40 % seizure reduction effect in addition to attaining enhanced attention and memory functions. TMS provides top-level spatial precision but tDCS allows low-cost portable treatment that suits home use. Studies show that patients experience minimal and short-term discomfort on their scalp but only minor headaches as reported side effects.

COMPARISON WITH EXISTING METHODS

Compared to pharmacological treatments, NIBS offers a non-invasive alternative with fewer systemic side effects. Unlike surgery, which requires invasive intervention, NIBS is safe, repeatable, and adaptable. However, cost (TMS), lack of standardization, and patient response variability remain challenges to clinical adoption.

CONCLUSIONS

NIBS is a safe and effective alternative for pediatric epilepsy but requires protocol standardization, accessibility improvements, and long-term efficacy validation. Future research should focus on biomarker-driven personalized treatments, AI-optimized stimulation, and affordable device development for broader clinical applications.

Comparative Efficacy of Neuromodulatory Strategies for Drug-Resistant Epilepsy: A Systematic Review and Meta-Analysis

OBJECTIVE

The study aims to evaluate the efficacy of neuromodulatory strategies for people who have drug-resistant epilepsy (DRE).

METHODS

We searched electronic repositories, including PubMed, Web of Science, Embase, and the Cochrane Library, for randomized controlled trials, their ensuing open-label extension studies, and prospective studies focusing on surgical or neuromodulation interventions for people with DRE. We used seizure frequency reduction as the primary outcome. A single-arm meta-analysis synthesized data across all studies to assess treatment effectiveness at multiple time points. A network meta-analysis evaluated the efficacy of diverse therapies in randomized controlled trials. Grading of Recommendations, Assessment, Development, and Evaluations was applied to evaluate the overall quality of the evidence.

RESULTS

Twenty-eight studies representing 2936 individuals underwent 10 treatments were included. Based on the cumulative ranking in the network meta-analysis, the top 3 neuromodulatory options were deep brain stimulation (DBS) with 27% probability, responsive neurostimulation (RNS) with 22.91%, and transcranial direct current stimulation with 24.31%. In the single-arm meta-analysis, in the short-to-medium term, seizure control is more effective with RNS than with invasive vagus nerve stimulation (inVNS), which in turn is slightly more effective than DBS, though the differences are minimal. However, in the long term, inVNS appears to be less effective than both DBS and RNS. Trigeminal nerve stimulation, transcranial magnetic stimulation, and transcranial alternating current stimulation did not demonstrate significant seizure frequency reduction.

CONCLUSIONS

Regarding long-term efficacy, RNS and DBS outperformed inVNS. While transcranial direct current stimulation and transcutaneous auricular VNS showed promise for treating DRE, further studies are needed to confirm their long-term efficacy.